Field Report

* fields are compulsory

• Address Where Incident Occurred *
  

• Date of Problem *
  

• Part Number/Product Description *
  

• Product Manufacture Date *
  

• Description of Problem *
  

• Description of use/installation details
  

• Place of Purchase *
  

• Date of Purchase *
  

• Contractor *
  

• Contractor phone number *
  

• Contractor address
  

• City
  

• State
  —Please choose an option—AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY

• Zip Code
  

• Operating Temperature
  

• Operating Pressure
  

• Type of solvent/cement used
  

• Type and brand of pipe used
  

• What part of the product had the issue (where did it leak from or fail?) *
  

• When did the failure occur *
  —Please choose an option—product arrived defectiveduring installationduring testing (number of stories or PSI of pressure)post installationunknown

• If post installation- How long had the product been installed?
  

• Who found the issues and how was it first noticed?
  

• Is this the only product with which you have had the issue, or is it an issue that repeats itself?
  

• What was the water pressure or force on the product?
  

• Was there damage and if so, what was damaged?
  

• Pictures
  

  Maximum upload size: 20MB, File Format: jpg, jpeg, png, gif only

  Select multiple files with CTRL and Shift keys.

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